That is the cut-off time for eating or drinking. With only one exception (described below), I instruct my patients to take nothing after midnight, even though their surgery may not be scheduled until mid-afternoon. There is a good reason for this rule.
Liposuction is generally performed under anesthesia. The type of anesthesia can vary. It is standard practice to insert an intravenous line, usually in your arm or the back of your hand. The fluid which enters your body during the intravenous line supplies you with water and electrolytes-minerals that are similar to those normally in your blood. The solution also contains glucose, supplying energy.
Usually, at least at The Liposuction Institute, liposuction is performed under anesthesia, and is often combined with a mild sedative or tranquilizer. The sedative can be injected directly into the intravenous line. In the event that, during surgery, it seems wiser to shift to the use of a general anesthetic, we must be sure your stomach is empty. The majority of liposuction patients have no trouble with either a local or a general anesthetic. However, by being sure your stomach is empty before surgery, we reduce the risk of possible complications considerably.
Most physicians will give you this advice, and it is considered standard medical practice.
If an antibiotic has been prescribed for you by your liposuction surgeon, and if you have been specifically instructed to do so, you may take one antibiotic pill on the morning of surgery. Swallow this pill with a maximum of one ounce of water. It is important that you do not drink more than this.
Do not worry about becoming thirsty or dehydrated during surgery. The fluid administered intravenously will meet all your needs.
GETTING READY
The night before you are scheduled to come to the office or surgical suite for your liposuction, take a long shower. Unless your doctor has given you different instructions, use a strong soap to scrub thoroughly the area in which you will have liposuction. Some physicians will recommend the use of phisohex, or another special washing agent.
WHAT TO WEAR
It is best to wear comfortable clothing that is not tight or restrictive. Although you will remove your regular clothing for the actual surgery, you will still need to dress to go home, and you will want to feet as comfortable as possible.
Do not wear rouge, lipstick, blush, facial powder, fake eyelashes or eyeliner of any type to the office or clinic when you go for surgery. If you customarily wear nail polish, remove it from fingers and toes before you come. We must be able to check your skin coloring as a guide to the appropriate amount of anesthesia during the surgery. If you do put make-up on, you will just have to take it off before surgery. It wiser to save time and not bother.
Do not wear any wig or false hairpiece.
ARRANGING TRANSPORTATION
You can drive yourself to the site of surgery. We do urge strongly, however, that you make arrangements with a friend or family member to take you home after the operation. If he or she will be picking you up after surgery, we can estimate the time you will be ready to leave. Your surgery usually will not take more than two hours, depending upon the type of liposuction and the extent of the operation. You will spend an additional one to two hours in the recovery room.
At The Liposuction Institute, we will be glad to tell your friend or family member how close we are to that estimated time, so that the person knows approximately when to come to meet you. Although it is certainly possible for your friend to wait at the office, surgical suite, or hospital during your surgery and recovery room period, it is not at all necessary.
WHEN YOU WALK IN
You may feel nervous when you enter the office. This is only natural. After all, you have made a big decision when you choose to have surgery. If it makes you feel better to talk about your concerns to your nurse, to the doctor’s staff, or to the doctor, you should feel free to do so. You should not feel embarrassed. These experienced professionals have seen literally thousands of patients go through surgery. Many of these patients have felt just as you are feeling, and have been relieved when the operation was over. Other patients have reported a feeling of anticipation and relief-anticipation, in the sense that they are looking forward to the new body image that liposuction will help provide, and relief that they have made a decision so important to their futures.
As you get ready for surgery, you will be asked to empty your bladder. If you wear contact lenses, you will be asked to remove them, so you should plan to bring along a case in which they can be kept during surgery. You will be asked to remove dentures or removable bridgework.
When you meet your surgeon before the operation, he or she will make drawings or markings on your skin as guidelines to the surgery. Your doctor may indicate the location of blood vessels and body structures, or may draw circles or ovals to help him plan in detail where fat deposits will be removed. The markings on your skin may still be visible after surgery, but will fade away rapidly.
You will almost certainly be asked to sign a surgical consent form-a standard document that gives your surgeon written permission to perform the operation and acknowledges that you have received information about the surgery. Read the document carefully before you sign. Ask the doctor to explain anything you do not understand. Although the “surgical consent paper” is a formality, it is important, and should be taken seriously. You will be draped before the surgery. Sterile cloths will be placed over the parts of your body that are not being worked on.
You will be asked to remove jewelry, eyeglasses, contact lenses, and (often) dentures or removable bridgework. If you do not want to remove a plain wedding band, your doctor or nurse can secure it with a small adhesive bandage. Because of the possibility that a ring can slip from your finger while you are under anesthesia, you will want to take off a ring with diamonds or other precious stones, and give it to someone for safekeeping. Better yet, do not wear jewelry to the office or surgical suite on the day of the surgery.
ANESTHESIA
The type of anesthesia that your doctor plans to use will have been discussed with you before surgery, so that it comes as no surprise. Most usual, for liposuction, is intravenous anesthesia with mild sedation and a tranquilizer. The person who administers the anesthesia will make a small injection in one of your veins, usually in an arm or leg, and start the intravenous solution running. You may be asked to count backwards, or to respond to the anesthetist in some other way.
Other types of anesthesia can be used for liposuction, such as a regional block-either an epidural, or a spinal anesthesia. Or, general anesthesia may be more appropriate for your particular operation. Sometimes, especially when the area for liposuction is small, your surgeon may choose to use simple local anesthesia, injected to numb the site for surgery.
Rest assured that your doctor will not start the operation until he or she and the anesthetist or anesthesiologist are sure you are ready. Liposuction, although not a terribly painful operation, is still surgery-and traumatic enough that you will want to have it done under the appropriate anesthesia.
When my patients ask me, ‘Will it hurt?’ I give them a truthful answer. “The most discomfort you will feel during the operation,” I tell them, “is likely to be the stick of the needle as it is placed in your vein for the intravenous injection.”
The skill of your doctor and of the person administering the anesthesia will determine just what you feel. However, the fact that many people have had liposuction performed on different body parts at subsequent intervals is proof that they did not fear second, or even third, surgeries.
Your specific needs for anesthesia will be discussed with you by your doctor.
THE SURGERY
We have previously discussed the general theory behind liposuction, so that you already know how the process works. Basically, while you are under an appropriate form of anesthesia, your surgeon will make tiny incisions, will insert a blunt (smooth-edged) cannula, or tube, and will suck out excessive fat cells from the unwanted deposits by connecting the tube to a special type of vacuum pump. Surgeons performing liposuction today use either the “dry” method, or the “wet” method. In the “wet” method, a special chemical solution (insert names of chemicals) is injected which helps to break down the fat cells, making it easier to remove the fat. At The Liposuction Institute, I use the “double wet” method-a technique which I originated. I make the incisions, inject the solution, suction out the fat, inject the solution again, and suction the fat a second time. I have found that this technique produces far better results than either the “dry” method or the one-time injection of the solutions.
Depending on the extent of the surgery and the particular body parts for which liposuction is being performed, you will be tightly bandaged after the operation has been completed. Or your doctor may have ordered a special garment for you, similar in appearance to a panty girdle or corset. If so, the garment will be placed on you while you are still on the operating table.
Your doctor will have talked with you beforehand about the length of the operation. Usually, liposuction will take a maximum of two hours, and often substantially less, depending on just what procedures you are having. If a friend or relative is waiting at the clinic while surgery is being performed, you can ask that he or she be notified when the operation is over.
After surgery, while you are still under sedation, you will be taken to a recovery room. There, under the watchful care of skilled staff members, you will remain for an hour or two, until your doctor is satisfied that you are ready to leave. Your blood pressure, heart rate, and other body functions will be monitored and checked at appropriate intervals.
Although you will be walking and alert when you leave the clinic, office, or surgical suite where the operation was performed, it is not a good idea for you to drive yourself home. You will be asked to arrange ahead of time for transportation home-either by having a friend pick you up and take you, or by having a taxi take you directly home. Going home by car is much better than going on public transportation.
As you are preparing to leave, your doctor will most likely check you personally, and answer any questions. It will be best if you or the person who takes you home receives written instructions for your post-operative care. That way, you will have a handy checklist to help you remember what you should and should not do. If you have specific questions, you may want to write them down ahead of time and give them to a staff member when you arrive at the office on the day of surgery. That way, the doctor can be sure to go over all the points you want to know about.
Regardless of whether you are given written or verbal instructions, you should always be given a telephone number you can call day or night if you are having considerable pain or bleeding, or if you feet extremely unwell. Your doctor should make clear to you the conditions under which he or she wants to be notified immediately.
In my opinion, a responsible physician who performs liposuction will always be able to be reached quickly in a post-surgical emergency. Although the chances of this happening are extremely small, you should have access to your physician or to a member of the surgeon’s staff during your convalescence. Even if you reach an answering service when you phone, the operator should get hold of an appropriate staff member to return your call promptly.
Your activities after surgery are discussed in the next chapter.